The Inevitability of Decline

 

As you age everyday is a mystery.  In the morning you wake up and like a computer booting up do a systems check.  Knee working, back not hurting, headache nope feel fresh, urinary system functioning, the list goes on… everything okay… check… it’s going to be a good day.  Then the morning routine kicks in.  A handful of pills and a cup of coffee.  

Salvador Dali

At some point there is a certain realization that nothing will ever get better.  When you have a car you can at least buy a new set of tires.  There is a good chance that they will work as good as the original ones if not better.  Every time I have to replace some part of my house I always ask the service man how this new version of whatever I had will make my life better.  Typically they will shrug and give me a look that says, “Just wait for the bill.”  Sometimes, not to be defeated, I will pore over the service manual or promotional material and relish the smallest detail.  I definitely did this when I had to spend 13,000 dollars to replace my HVAC system.  This one has a faster fan, there it is, my life has improved.  

There is simply no equivalent with the human body.  Everything is repair and mitigation.  Fix the joint that is broken, take a pill to slow the decline.  Drugs are meant to heal us or slow deterioration.  I can think of no example of any that will make you better than you ever were.  I remember the first time my son came in with a severely skinned and scared knee from skateboarding.  His perfect skin is ruined I thought as I dotted the blood and applied antibiotic.  It’s like the first time a new car gets a chip or a ding.  You cared so much and then, almost overnight, the next one is no longer a shock.

The last time I visited my doctor I told him I felt is was depressing when I looked at how many pills I take.  He looked over the ever growing list and said “you know I would not be concerned.  When I compare you to most of my patients you are doing pretty well.”  

This morning was a bad day.  I started okay but soon after waking I had a blurry incident.  I do not know why it happens but sometimes, usually in the morning, my vision will get fuzzy, especially on the peripheral.  I find it hard to focus and view any electronic screen.  It seems like if I close my eyes it passes in 10-15 minutes.  Maybe it is sugar related?  Diabetes?  Allergy?  No idea… perhaps it is the beginning of the end.  I have checked blood pressure and sugar when it happens and it is all normal.   

Recently, as I will soon enter retirement, I have been contemplating spending a couple months out of the year in Thailand.  Aside from enjoying Thailand a goal would be to spend a fragment of the time accomplishing all my medical needs and examinations.  My last professional assignment in Thailand led me to a revelation about health care.  In many ways receiving health care in a foreign country is scary.  We are taught to think of our American system as superior to all others.  Life experience has taught me that this is largely American propaganda used to encourage Americans to tolerate a system that is overpriced with lousy service and declining outcomes.  

Thailand like many countries has a private health care system that is as modern as top tier hospitals in the United States.  Cliental comes from around the world to be treated by doctors schooled in some of the best medical universities in the world.  While payment for service is often upfront bills are clearly explained and typically a fraction of what an American hospital would charge. While living there I would often become frustrated with Blue Cross Blue Shield when I submitted an expense.  At times the American insurer would refuse payment because the cost was simply below their minimum for coverage.  In America they would cover the procedure at enormous cost.  In Thailand it would be disallowed because it was not pricey enough.  I often felt like they should be grateful for my thriftiness and send me a letter of thanks.

Care abroad was taken far more seriously than in the United States and often an incident that would be treated as out patient in America was afforded full hospitalization in Thailand.  I experienced an incident when I incurred severe food poisoning and was hospitalized for three nights.  The room was $180 dollars a night and I was provided around the clock care.  In America the room alone would have been in excess of $13,000 dollars.  

  

The preventative care and decline management was also much better.  Basically once a year you pay about 500 bucks for the “Executive Plan” and in the course of 4 - 6 hours you are cycled through a long list of diagnostic analysis.  A typically young and quite beautiful Thai nurse dressed in a traditional nursing uniform will meet you and escort you from one office to the next.  Sonogram on kidneys and gut, x-rays, blood work, cardio exams on treadmill, sound, vision, EKG on and on.  Then at the end your attending doctor looks at everything and refers you to specialist to address any issue.  Your nurse guide will then lead you around from one doctor to the next accomplishing in four hours what would take 6 months to schedule in the US.  You get two included specialist and after that you pay a small extra fee for each doctor.  All additional charges are itemized and explained.  Any medications are prescribed and distributed.  They even give you a lunch coupon.  

It all makes me wonder if perhaps there is not a better way to manage decline.  I often tell my wife and son that should I become debilitated physically or mentally just take me to Thailand or the Philippines and hire me a care nurse.  When I told this to my American father the idea seemed incomprehensible however, when you have lived the care as I have you understand.  The median cost for a nursing home in America in the state of Oregon is nearly $12,000 dollars a month.  The cost of a two bedroom apartment in Bangkok runs $300.  A 24 hour nurse for home care would run approximately $1,000 US per month for a registered RN.  

Unfortunately as I age I realize that consideration of these issues is simply part of life.  As we age we watch our parents decline and struggle to care for them.  At the same time every look into a mirror reminds us that we are not far behind.